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Letters |
Post Graduate Institute of Medical Education and
Research
Chandigarh 160012, India
Minimizing radiation dose in pediatric imaging is a crucial issue that has been emphasized and reemphasized in recent years. The radiation threshold that can induce carcinogenesis is lower than previously believed, and tissues of children are 10 times more radiosensitive than those of adults [1]. AJR has taken the lead and published several articles in the recent past to educate readers about the need and means to decrease pediatric radiation dose during CT examinations. Although the role of radiologists and clinicians has been scrutinized, the role of manufacturers has been largely overshadowed. Our communication is aimed at suggesting simple modifications in software to enable delivery of reduced radiation dose to pediatric patients during CT.
In our experience, the most common cause for excessive radiation to a pediatric patient is the use of adult protocols [2]. Radiographic technicians are more comfortable with adult scanning protocols, which they use more frequently than dedicated pediatric scanning protocols. Lack of adequate adjustment of the milliamperage setting in accordance with a patient's age, which leads to excessive radiation dose to pediatric patients, has been reported earlier also [2, 3]. Because the milliamperage setting required for scanning adults is higher than that for pediatric patients, the use of adult protocols results in unnecessary radiation to pediatric patients. Ideally, the radiographic technician should modify the tube milliamperage setting according to the child's weight before scanning. However, frequently it is not done on account of ignorance or work pressure.
The following minor modification in software could deal with this problem. At the time of registering patient data, the software could make it mandatory that the technician enter patient weight. Once the patient data have been entered, the software could flash a message for confirmation of body weight (purely as a matter of abundant precaution). After the technician has confirmed the body weight, the software could automatically change the milliamperage setting according to the patient's weight. Alternatively, the software could flash a message regarding the appropriate milliamperage setting.
We also recommend that a weighing machine be kept within the CT suite. We believe that these minor modifications could reduce inadvertent and excessive irradiation of pediatric patients.
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